Fully Digital Workflow for Immediate Prosthetic Implant on Microsurgery Fibula Flap for Mandibular Reconstruction

Immediate implant-retained surgery on the fibula using the traditional method is a technical challenge in mandibular reconstruction and can worsen the following prosthetic process. A digital workflow with multiple surgical guidance tools can help ensure accuracy and even immediate temporary prosthesis placement in mandibular reconstruction using fibula flaps.

In this article, we present a digital workflow for dental implant placement in the fibula flap using a 3D-printed surgical guide before the vascularization of the flap and temporary prosthesis immediately during surgery.

This procedure includes resection of the mandibular lesion, immediate reconstruction with a fibula flap, immediate implant placement, and provisional prosthesis placement. Our patient received both mandibular reconstruction and dental implant prosthesis completed in a single day at the tumor resection stage, which enormously shortens the recovery time without teeth to zero. Regarding the implant position on the fibula, the results were awe-inspiring. We measured and compared with the assumed plan; the neck deviation was about 1.47mm, the average change in implant height was 1.06mm, and the average implant deviation angle was 9.17 degrees. The above results helped the process of trying on temporary restorations and grinding the occlusion completely smoothly, even with the permanent restoration process later.

We report two cases utilizing the fully digital "Jaw in a Day" workflow. VSP and surgical guidance are essential in the precise cutting and shaping of the fibula flap and the prosthetic restoration with dental implants.